Considering Prehab Before Knee Replacement

Last week we shared a blog about Post-Total Knee Replacement Personal Training (you can check it out here).

This week, we are sharing with you the reasons why Prehab is strongly recommended before getting a Total Knee Replacement.

In preparing your body for a major life-event, doing

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What is Total Knee Replacement?

Surgical replacement of the knee joint, also called total knee arthroplasty (TKA) or total knee replacement (TKR), is considered the definitive treatment for symptomatic end-stage osteoarthritis of the knee. [1]

Osteoarthritis is a chronic condition in which cartilage (the material that cushions joints) breaks down. Pain and stiffness tend to worsen over a period of time. Symptoms of osteoarthritis may include joint pain with activity; night pain; morning stiffness; limited motion; joint inflammation; a noise from the knee; and in severe cases, joint deformity. Weight bearing activity such as walking, climbing stairs, bending, kneeling, or squatting typically increases the pain. Of the 11 million adults in the United States who have been estimated to have this diagnosis, 4 million have undergone a knee replacement. [2]

The increase of knee replacements is related to a growing older population, a rise in life expectancy, and the obesity epidemic. The total cost for a TKA can be likened to that of a new car. 

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What is Prehab and why should you consider it, if you are about to get a Total Knee Replacement?

If you want to improve the odds for a successful knee replacement: consider prehabilitation (prehab). Prehab is an exercise program that is generally started at least 6 weeks prior to surgery.

While undergoing rehabilitation for up to 3 months following total knee arthroplasty (TKA) to heal and maximize recovery to the fullest is the norm, prehab is not yet a widely known concept.

According to a study of the Journal of Bone & Joint Surgery (JBJS) physical therapy before joint replacement surgery, or "prehabilitation," can diminish the need for postoperative care by nearly 30 percent, saving an average of $1,215 per patient in skilled nursing facility, home health agency or other postoperative care. [3]

Healthcare costs can add up quickly. With proper prehabilitation these costs can be reduced, and in some cases, even avoided. That aside, there is no price to be put on moving better and feeling more sound, sooner!

The rewards of prehab become apparent 24-hours after surgery. The day after knee-replacement surgery, patients are expected to be walking (with assistance) for short distances, i.e. to the bathroom. In 3 to 5 days, they must be able to go up and down 2 to 4 steps, and walk 50 to 100 feet before leaving the hospital. Having the muscle fiber toned and strengthened before the surgery empowers the patient, immediately. 

A prehab program is designed to improve strength and can help TKA candidates achieve some of those milestones in less time.

Patients who are more fit prior to surgery may have shorter hospital stays. They also increase  their chance of outpatient rehab versus being referred to a rehab facility for inpatient service. 

It is reported that patients who participated in a pre-surgical fitness program, experienced an increase in preoperative functional status, and improvement in quality of life; and, a reduction in postoperative length of hospital stay, and time in the intensive care unit. This study may have particular relevance to total joint arthroplasty, because preoperative functional status has been shown to be strongly related to postoperative status in hip and knee arthroplasty patients. [4]

Therefore, Pongo Power’s Medical Exercise Team focuses not only on post-rehab (which is a logical step after TKA/TKR) but also on prehab.

Clients who are planning arthroplasty begin prehab 6-10 weeks before their scheduled surgery. During an initial visit, clients fill out a health history questionnaire. We assess balance, strength, range of motion and level of function. We then customize an exercise plan to match clients' needs and fitness level.

Ideally, prehab clients train twice a week.  Home-based exercise programming rounds out the individual prehab program. A gym set up is not required for the home-based program, which consists of no more than 3 exercises and/or stretches to be performed  daily.

One of our recent knee replacement clients, Ruth C. says this about her experience with prehab at Pongo Power:

I was scheduled for a TKR and skeptical about choosing a trainer to help me strengthen my knee prior to surgery. With severe arthritis, I needed someone who was knowledgeable and would help me, rather than exacerbate the problem. A friend recommended Pongo Power's Medical Exercise Specialists, and I’m so grateful. Karin's help, not only prepared me for the surgery, but also facilitated my recovery. She even reached out to my physical therapist to coordinate my care. Needless to say, she went above and beyond.

If you are interested in learning more about Prehab, or Medical Exercise, please email us at medicalexercise@pongopower.com.

References:
 1. Richmond J, Hunter D, Irrgang J, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am 2010; 92:990–993
 2. Weinstein AM, Rome BN, Reichmann WM, et al. Estimating the burden of total knee replacement in the United States. J Bone Joint Surg Am 2013; 95:385–392
 3. R. Snow, J. Granata, A. V. S. Ruhil, K. Vogel, M. McShane, R. Wasielewski. Associations Between Preoperative Physical Therapy and Post-Acute Care Utilization Patterns and Cost in Total Joint Replacement. The Journal of Bone & Joint Surgery, 2014; 96 (19): e165 DOI: 
 4. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum 1999; 42: 1722–8.

Come in for a free Medical Exercise fitness assessment today!

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